Tag Archives: Health Insurance

A mouthful of healthy teeth has become a luxury in America, and the divide between rich teeth and poor teeth has become a stark symbol of inequality. Poor dental care can be both humiliating and life-threatening, and those who wait in lines for hours at free clinics in tents or local stadiums are often given the chance to fix one thing, and little else.

Los Algodones, Mexico — tucked into the sharp corner where California and Arizona meet at the border near Yuma — has 600 dentists among its 6,000 residents, giving it the nickname “Molar City.” As Republican senators cobble together a plan to repeal Obamacare behind closed doors, little has been done to address the dental crisis currently unfolding in the United States, where 114 million Americans don’t have dental insurance.

Dental insurance has only been commonplace for about thirty years in America. As a 34 year old, I remember trips to the dentist in the mid-1980s as intense and frequent. Fluoride was a cure-all at the time; I was given extra-fluoridated chewables on top of our already-fluoridated town water supply, which left my teeth strong but streaked with white stains. When I lost my four adult front teeth in a playground accident at ten, I didn’t get porcelain veneers until I was 18. They cost $1000 each, so we had to save.

In Los Algodones, porcelain metal crowns that can cost $1500 in the states are just $180 each — one patient got fourteen in a single go. “We’re helping the United States take care of the people they are not able to,” the mayor of Los Algodones told Buzzfeed in their recent profile of the city. And many of those people the US is unable to take care of just put the new president in office.

Jennifer Ure smiles sheepishly through the numbing agent as we stand on the sidewalk outside her dentist’s office. She’s just had her first round of surgery to replace three crowns on the right side of her mouth and is speaking with a lisp. The crown would have cost $600 back home in Ashland, Oregon; here, it’s $190. Her sister, Dana Gross, is here, too. Both are retired, both lack dental insurance, and both have been coming to Molar City for years.

“I’m on Medicare, and I can’t afford dental insurance,” Ure says as she starts to choke up. “I just can’t afford to pay.”

Both sisters warn that to get quality care in Molar City, you have to get recommendations from people you know and trust.

“You really need to do your research,” Ure, 61, tells me. “You can get some who don’t know what they’re doing, which happened to me.” Her first procedure here seven years ago didn’t go well — the implants a dentist put in fell apart soon after Ure returned to the US.

Ure, like most of the Americans I spoke with in Molar City, voted for Trump. The president’s dark warnings of Mexican rapists and gangsters coming into the US haven’t deterred his supporters from coming to Mexico for dental care.

Of course, that’s not to say the Mexicans providing care don’t see the irony.

David Gil, the manager of TLC Dental, says he’s become Facebook friends with many of the patients, and “everything is Trump, Trump, Trump.” But so far, he hasn’t seen a drop-off in customers who support the president — and he hasn’t had any problems with visiting Americans. “I think when it comes to racism, people hide it … [but] why else would you vote for him?”

“I think it’s a little bit odd, but we can’t judge them on how they voted, so we just try to respect them,” says Margo Carilla, who works as a translator for a dentist in town.

I’m part of the 63 percent of Americans who don’t have money to cover an emergency costing $500 or more. I don’t own a car or a house, so in the unlikely event of the aforementioned emergency (knock on wood for me, please), my personal crisis would be health expenses uncovered by Medicaid. Like the people you’ll meet in the following stories, I too would turn to crowdfunding.

Everyone, in my opinion, deserves healthcare coverage, and crowdfunding shines a spotlight on the insufficiency of the United States healthcare system. It also demonstrates that the internet is far from democratic. Crowdfunding takes time, energy, and a knack for marketing. Not everyone has these privileges or skills, and when it comes to paying medical bills or seeking life-saving surgeries, that chasm can be fatal.

Just today, a trans man I follow on Instagram posted a picture of the letter he received in the mail saying his health insurance would not cover his top surgery. For trans and gender non-conforming people, the cost of life-affirming medications and operations are steep—financially, physically, and spiritually. According to GLAAD, 19 percent of transgender people don’t have any form of health insurance. Hormone therapy and gender confirmation surgeries can cost tens of thousands of dollars. Instead, many trans people have turned to the internet, using PayPal donations or hosting YouCaring or GoFundMe campaigns, to ask their friends, families, and total strangers for financial assistance.

Donating to a medical crowdfunding campaign requires donors to be at once more intimate with and more judgmental of the recipients. At its most basic and most callous, the act of giving boils down something not unlike comparison shopping: Who, out of all the people who have shared their tragedy on the Internet, is the most deserving of money? And, before that, who can entice donors to click?

As medical crowdfunding has become more popular, so too has the idea of its so-called “perfect victim,” said Margaret Moon, a bioethicist and professor of pediatrics at Johns Hopkins University: the person whose inability to pay for their care came down to sheer bad luck—and bad coverage, if they had any insurance at all. “They’d done everything right, they’d explored all the possibilities and were still left short,” she said. “The people donating to these sites don’t know if somebody’s made a request because they just couldn’t figure out their insurance, or because their insurance failed them. Wouldn’t you be more willing to donate to someone who had played out their insurance?”

Evan Karr is a a precocious 13 year old Kentuckian who was born with tetralogy of Fallot, a heart defect. Evan has had three heart surgeries, and at the top of Petersen’s story, he’s gearing up for a fourth.

Most of the successful campaigns on a crowdfunding homepage fall under the rubric of “fighting unfairness,” a designation that expands to include one of GoFundMe’s most successful campaigns of all time (for Standing Rock) but mostly signifies struggles against diseases that seemingly strike at random: cancer, genetic disorders, and other afflictions ostensibly out of the victim’s control. Such conditions are often referred to as “faultless.”

It’s far harder to fund so-called “blameworthy” diseases—addiction and mental health in particular—that are popularly conceived as either the fault of the victim or somehow under their control. You rarely see campaigns for adult heart disease, for example, or “getting my life together as a single mom”—both are viewed as the result of “choices” instead of “needs.” If there’s already a hierarchy of affliction and need in this country, then crowdfunding often works to exacerbate it.

Luke O’Neil’s feature for Esquire opens with an anecdote about Kati McFarland, a 25-year-old young woman with Ehlers-Danlos syndrome who turned to crowdfunding to offset the cost of medical care. McFarland garnered national attention when she confronted Sen. Tom Cotton about his perspective on the Affordable Care Act.

After reading several of these crowdfunding stories, I was feeling a little jaded. I couldn’t help but cringe at the following, from YouCaring’s director of online marketing:

“The secret prize for people who raise money on the site is they find out how much people care about them,” says YouCaring’s [Jesse] Boland. “The money is the primary ask but they end up being better off for having connected to their community, so they get a sense of peace and belonging.”

O’Neil also spoke to editors from Gizmodo, Uproxx, Upworthy, and the Washington Post about their experiences studying and spotlighting viral campaigns.

Jimmy Lin is the founder of the Rare Genomics Institute, which he describes as “Amazon-slash-Kickstarter for science.” Lin’s organization matches families with researchers and geneticists from RGI affiliates and helps them raise money to cover the costs of expensive tests:

“The biggest thing we talk about with our team is, ‘If this was our child who was sick, what extent would we go to to help them?’” Lin says of RGI’s efforts. “If this was our kid that was sick, this is exactly what we’d do.”

Repeal and replace: Republican candidates used these three words throughout the election cycle almost as an incantation. There was no other option for dealing with Public Enemy #1: Obamacare. When President Trump took office they became a battle cry for Republicans intent on undoing his predecessor’s signature legislation.

But what would repeal and replace look like? Last week, the House Republicans unveiled draft legislation to replace the Affordable Care Act, seven years in the making. The American Health Care Act shares part of the old plan’s name, but not many of its current features. Everything from the insurance mandate to Medicaid expansion is missing from the new plan, and leaders from both sides are unhappy with the half-baked results. Read more…

When the ACA was passed in 2010, Ana Maria Garza Cortez could hardly believe it. She’d spent decades trying to help poor people in San Antonio get health care. She knew the barriers they faced because she’d faced them too. She’d grown up in West Side housing projects, and her family never had health insurance. She and her seven siblings didn’t go to the doctor when they were sick. “That was a luxury,” Cortez says. “My mom loved us, but we were poor. She would wait to see if whatever we had would go away.” If it didn’t, she would take them to the neighborhood clinic or, more often, the emergency room. Since Cortez graduated from Our Lady of the Lake University, in 1990, she has worked with nonprofits, usually in health care. She serves as the vice president of development and marketing at CentroMed, one of the city’s sliding-scale, safety net clinics, with 23 locations in the area, many in the city’s poorer neighborhoods. She became one of the leaders of EnrollSA, along with Guajardo and Joe Ibarra, the deputy state director and operations manager at Enroll America. Among the city’s health care advocates, Cortez is admired for her energy and passion. “We call her ‘Santa Maria,’ ” Guajardo says. “She lives for the community. It’s in her bones.”

Now that President Obama had pushed through a law making health insurance available, at least in theory, to everyone, Cortez was elated. She knew Texas needed help—the state had five million uninsured residents, more than any other—and her hometown especially so. Officials figured there were 300,000 or so uninsured in the city and surrounding Bexar County. Latinos make up 60 percent of the San Antonio population, but 75 percent of the city’s uninsured. On the South Side, which has a significant Latino population, rates of diabetes, hypertension, and obesity were higher than average. For generations, says Santos Hernandez, who grew up in the Rio Grande Valley and now works as an application counselor at CentroMed, many in the poor Latino population, rural and urban, have had a three-step system for dealing with illness. “First you go to church, light a candle, and pray. Second, you see a curandero. Finally, you borrow money and take your kid to the doctor.”